Anyone considering surgery should approach the decision with a healthy amount of respect and caution especially when the surgery is elective (or planned) and is non-essential surgery (as aesthetic or cosmetic surgery generally is). All surgical procedures have limitations in terms of what is an achievable outcome and it is important that your expectations match what is possible through surgery.
The choice to go ahead with surgery is always (or should always be) taken after due consideration of the risk benefit balance for the procedure. Although the majority of patients do not experience problems it is important that you fully understand all the potential risks and complications of Liposuction surgery. It is important that you take the time to read over them again prior to your next consultation.
Scarring
All surgery leaves scars, some more visible than others. Although good wound healing after a surgical procedure is expected, abnormal scars may occur within the skin and deeper tissues. Scars may be unattractive and of different color than the surrounding skin tone. Scar appearance may also vary within the same scar. Scars may be asymmetrical (appear different on the right and left side of the body). There is the possibility of visible marks in the skin from sutures. In some cases, scars may require surgical revision or treatment. Scars can appear thick, red and raised all or part of the way along the incision line (a hypertrophic scar) or more rarely can involve tissues beyond the incision itself (and can resemble a badly healed burn), this is known as a keloid scar. Additionally, scars can tether to underlying structures or become abnormally pigmented. It is possible that additional treatments may be required for adverse scarring.
Bleeding
It is possible, though unusual, to experience a bleeding episode during or after surgery. Should post-operative bleeding occur, it may require emergency treatment to drain accumulated blood which would entail a return trip to theatres. Intra-operative blood transfusion may also be required though this is rare. If a collection of blood accumulates (a haematoma) that is small enough to not be detected clinically this may result in a spontaneous discharge at a later date (if this happens it is usually a few weeks following surgery) or the haematoma could become infected forming an abscess which may need to be formally washed out in theatre. Fortunately, most small haematomas resorb spontaneously.
Do not take any aspirin or anti-inflammatory medications for ten days before or after surgery, as this may increase the risk of bleeding. Non-prescription “herbs” and dietary supplements can increase the risk of surgical bleeding. Hematoma can occur at any time.
If blood transfusions are necessary to treat blood loss, there is a risk of blood-related infections such as hepatitis and HIV (AIDS). Heparin medications that are used to prevent blood clots in veins can produce bleeding and decreased blood platelets.
Seroma
A seroma can be best thought of as a collection of fluid beneath the skin at a surgical site. The composition of a seroma is much the same as that of blood but without the actual blood cells (it contains similar proteins and salts to blood) and is usually the result of lymphatic fluid accumulation (this is the 10% of the fluid that escapes from capillaries within tissues but does not return back to the veins via the small blood vessels but rather by the lymphatic drainage vessels) or by direct production from inflamed tissue. If this occurs there is the possibility it will need to be drained (often by simple aspiration with a needle or syringe, though rarely a further operation to may be required). If a seroma were to become infected it could form an abscess which could require further surgery to washout and drain.
Change in Skin Sensation
You may experience a diminished (or loss) of sensitivity of skin in areas undergoing Liposuction, sensation may be altered so that that touch is experienced as pins and needles of even frank pain (known as neuropathic pain). Such problems are rare but can be encountered following surgery. Such changes are usually temporary but can be permanent.
Pain
You will have pain following surgery. The intensity and duration of the pain varies from individual-to-individual following Liposuction. Very infrequently chronic pain due to nerve damage or nerve entrapment in scar tissue may arise following Liposuction surgery (neuropathic pain).
Skin Discoloration / Swelling
Bruising and swelling normally occurs following liposuction. The skin in or near the surgical site can appear either lighter or darker than the surrounding skin. Although uncommon, swelling and skin discolouration may persist for long periods of time and, in rare situations, may be permanent.
Skin Contour Irregularities
Contour and shape irregularities such as depressions or corrugations (rippling) may occur after Liposuction. Visible and palpable wrinkling of skin can occur. Any pre-existing irregularities (such as cellulite) may be amplified by Liposuction.
Redundant skin
Liposuction relies on skin contraction in order to achieve the end result desired. Failure of skin contraction will result in the appearance of flaccid or loose skin (think of a shopping bag with the contents removed). Skin contraction cannot be guaranteed and failure of skin contraction may require further surgery to remove the excess (which would incur additional fees).
Fat Necrosis
Fatty tissue found deep in the skin might die. This may produce areas of firmness within the skin or the underlying tissue. Fat necrosis may also result in discharge of liquid from the surgical incision due to fat liquification. Additional surgery to remove areas of fat necrosis may be necessary. If an area of fat necrosis were to become infected it would require further treatment with antibiotics or surgery. There is the possibility of contour irregularities in the skin that may result from fat necrosis.
Asymmetry
Although every effort is made to achieve a symmetrical appearance following Liposuction there is no guarantee of this following surgery. Pre-existing differences between the sides of the body, such skeletal asymmetries, differences in muscle bulk and fat deposition, as well as skin tone contribute to this. Skin fold asymmetries are unlikely to be changed following Liposuction.
Persistent swelling (lymphedema)
Persistent swelling following Liposuction surgery is possible. This is the result of changes in lymphatic drainage brought about by the surgery. Massage will help the swelling and it usually resolves over a period of months. Rarely such swelling can be permanent. It can affect any area of the body.
Surgical Shock
In rare circumstances, Liposuction can cause severe trauma, particularly when multiple or extensive areas are suctioned at one time. Although serious complications are infrequent, infections or excessive fluid/blood loss can lead to severe illness and even death. If surgical shock occurs after Liposuction, hospitalisation and additional treatment would be necessary.
Individuals undergoing Liposuction procedures where a large volume of fat is removed are at greater risk of complications. Patients contemplating large volume Liposuction (greater than 5000 cc’s), may be advised to have postoperative monitoring and aftercare that involves overnight hospitalisation.
Fat Embolism
A rare complication of Liposuction is fat embolism, whereby fat enters the bloodstream and lodges in an organ or tissue at a distant site in the body. This can produce extremely serious effects on the tissues involved including tissue necrosis and can result in death.
Damage to deep structures
A rare complication of Liposuction is injury to one or more of the structures deep in the tissues being treated. In the abdomen, this would result in potential damage to the bowel or internal organs and may necessitate further surgery (laparotomy), including bowel resection and stoma bag formation and may result in peritonitis or even death. In other areas of the body damage to the muscles, blood vessels or nerves is possible and this could result in the need for further surgery to repair any damage or even permanent loss of function or pain.
Considerations around the time of surgery
- Clothing to wear to hospital – We recommend you wear comfortable and loose clothing with a button or zip-top (such as a tracksuit).
- Keeping your skin clean – We recommend regular washing before and after surgery with tea tree wash.
- Post-operative garment – A supportive (but not tight) garment is highly recommended after surgery to speed up the resolution of any swelling. This should be worn for 6-weeks.
- Look after your dressings – Your wounds will be dressed in shower-proof padded dressings. These will need to be changed regularly as they usually become soaked through with wound fluid. It is normal for the small Liposuction wounds to leak for up to a week after surgery. It is therefore a good idea to sleep with an old towel on your bed when you get home from hospital.
- Post-operative follow-up – You will have a check-up with the nurse one week after surgery, and then a further appointment for the removal of tapes at 2-weeks. Later follow-ups will be arranged subsequently.
- Take things easy & slowly after surgery. Gentle movement after surgery is advised, no heavy lifting or jumping up and down for the first 2-3 weeks.
- Driving can be started at 1-2 weeks, and after 6 weeks you can generally get back to normal exercise.
- Scar management – This will be discussed with you at your 2-week post-operative appointment. Regular moisturising and massage of your scars is important, and silicone gel can help ensure your scars settle down as quickly as possible.
- Some people find using arnica very helpful for bruising and swelling.
